General pathology · The pathology laboratory

Biopsy: excisional, incisional, core needle, punch and fine-needle aspiration !

Technique

A biopsy takes a piece of tissue to look at under the microscope; the technique chosen decides what the pathologist can answer.

Updated 2026-11-01

What it is

A biopsy is the removal of tissue from a living person for study. Some techniques remove the whole lesion, some only part of it, some a cylinder of tissue and some just loose cells. Choosing the right one avoids repeat biopsies: a sample without architecture cannot show invasion, and a lesion cut through cannot have its depth measured.

Key facts

Excisional biopsy: removes the whole lesion with a rim of normal tissue; it diagnoses and sometimes treats.
Incisional biopsy: removes only part of a large lesion; it guides planning of the definitive operation.
Core needle biopsy: takes cylinders of tissue that keep their architecture; the usual way to study a breast lump.
Punch biopsy: a full-thickness cylinder of skin, useful for rashes and skin tumours.
Fine-needle aspiration (FNA): obtains loose cells, not tissue; quick and minimally invasive, but cannot show invasion.
Endoscopic biopsy: small mucosal fragments taken at endoscopy, colonoscopy or bronchoscopy.

Step by step

The clinician defines the question: what is the lesion, is it malignant, which markers does it carry?
The technique is chosen by organ, size, access and whether tissue architecture is needed.
If melanoma is suspected, the whole lesion is preferably removed so its thickness can be measured.
If lymphoma is suspected, a whole node is sent fresh, for flow cytometry and molecular studies.
The sample is labelled and fixed in formalin at once, unless fresh tissue is needed.
It is sent with the clinical data: age, site, imaging and the suspected diagnosis.

Which biopsy technique to choose

Technique	What it obtains	Advantage	Limit
Excisional	The whole lesion	Complete diagnosis and margins	More invasive; not suited to large lesions
Incisional	Part of the lesion	Useful in large lesions before surgery	May miss the worst area
Core needle	Cylinders of tissue	Architecture, grade and markers with little invasion	Small sample: sampling error
Punch	Full-thickness skin cylinder	Quick, done in clinic	Small or superficial lesions only
Fine-needle aspiration	Loose cells	Minimally invasive and fast	Cannot tell in situ from invasive, or follicular adenoma from carcinoma
Endoscopic	Mucosal fragments	Reaches hollow organs without surgery	Superficial; may miss deep invasion

Clinical notes

Suspicious breast lump: image-guided core needle biopsy before any surgery; it gives type, grade and receptors.
Suspicious pigmented lesion: excisional biopsy with a narrow margin; a superficial shave can transect the tumour and prevent measuring Breslow thickness.
Enlarged node with suspected lymphoma: a whole node beats an aspirate, because the diagnosis depends on architecture.
Sentinel node: the first node draining a tumour is removed and examined to stage without clearing the whole region.

Test yourself

Think of the answer, then tap the question to see it.

Which type of biopsy keeps tissue architecture and is the usual choice for a breast lump?

Core needle biopsy, which takes tissue cylinders and allows type, grade and receptor testing.

Why is fine-needle aspiration not enough to diagnose follicular thyroid carcinoma?

Because the diagnosis rests on capsular or vascular invasion, and FNA only obtains loose cells.

Which biopsy is preferred for a pigmented lesion suspicious for melanoma?

A complete excisional biopsy with a narrow margin, so that Breslow thickness can be measured.

How should a lymph node be sent when lymphoma is suspected?

Whole and fresh, so flow cytometry and molecular studies can be done as well as histology.

Add to my cards (4)

Elsewhere in DurgiPedia

← All of general pathology

Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.

Sources: Biopsy: MedlinePlus Medical Encyclopedia (MedlinePlus, US National Library of Medicine, 2024); How Cancer Is Diagnosed (National Cancer Institute, 2023); Pathology Reports (National Cancer Institute, 2023).

Spotted a mistake?We are always improving for the community. Tell us what is wrong and our team will review it.Report a mistake

Representative model, for educational purposes only.